Abstract

Parkinson’s disease (PD) is a progressive disorder that involves a marked functional degradation of the extrapyramidal nigrostriatal dopamine system. Present, palliative-only therapeutic strategies include (1) replacement of lost dopamine tone, for example through L-DOPA treatment (Rinne, 1987; Shoulson, 2000) or fetal mesencephalic transplantation (Lindvall et al., 1994), (2) post-synaptic dopamine receptor activating drugs including pramipexole (Rinne, 1987), or bromocriptine (Shoulson, 2000) and (3) surgical ablation such as globus pallidotomy (Lang and Lozano, 1998), among others. More recently, either deep brain stimulation (DBS) or thalatotomy (Bejjani, 2000) may offer paradoxically similar beneficial outcomes for some PD patients. Though aggressive clinical trials are still ongoing, DBS seems to be particularly effective in attenuating drug-induced dyskinesias that often develop during prolonged L-DOPA treatment (Nutte, 2000), and this reliably enough that the procedure has just been endorsed for wider use by the U.S. Federal Drug Administration. As yet, the specific mechanism by which DBS offers relief is unresolved.